Healthcare Provider Details

I. General information

NPI: 1174464499
Provider Name (Legal Business Name): MS. ANQUENETTA MICHELLE PENDLETON KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7278 CAHABA VALLEY RD APT 914B
BIRMINGHAM AL
35242-8410
US

IV. Provider business mailing address

7278 CAHABA VALLEY RD APT 914B
BIRMINGHAM AL
35242-8410
US

V. Phone/Fax

Practice location:
  • Phone: 205-903-0041
  • Fax:
Mailing address:
  • Phone: 205-903-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-118517
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-118517
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: